(b) No health care provider or practitioner may demand or request any
payment for clinical laboratory services, pharmacy services, radiation
therapy services, physical therapy services or x-ray or imaging services
furnished pursuant to a referral prohibited by subdivision one of
section two hundred thirty-eight-a of the public health law.
(c) No insurer shall be required to pay any claim, bill or other
demand or request for payment by a health care provider for clinical
laboratory services, pharmacy services, radiation therapy services,
physical therapy services or x-ray or imaging services furnished
pursuant to a referral prohibited by subdivision one of section two
hundred thirty-eight-a of the public health law.
(d) Every policy of accident or health insurance issued by a
commercial insurer and every subscriber contract issued by a hospital
service corporation, health service corporation or medical expense
indemnity corporation which provides coverage for clinical laboratory
services, pharmacy services, radiation therapy services, physical
therapy services or x-ray or imaging services shall include a provision
excluding payment of any claim, bill or other demand or request for
payment for such services furnished pursuant to a referral prohibited by
subdivision one of section two hundred thirty-eight-a of the public
health law.
(e) Every insurer subject to the provisions of this section shall
report to the commissioner of health any pattern of submission of
claims, bills or other demands or requests for payment submitted in
violation of subsection (b) of this section, within thirty days after
such insurer has knowledge of such pattern.
(f) Notwithstanding the requirements of subsections (c), (d) and (e)
of this section, an insurer reimbursing for clinical laboratory
services, pharmacy services, radiation therapy services, physical
therapy services or x-ray or imaging services is not required to audit
or investigate any claim, bill or other demand or request for payment
for such items or services furnished pursuant to a referral.
* NB There are 2 ยง 3231's
Structure New York Laws
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
3201 - Approval of Life, Accident and Health, Credit Unemployment, and Annuity Policy Forms.
3202 - Withdrawal of Approval of Policy Forms.
3205 - Insurable Interest in the Person; Consent Required; Exceptions.
3206 - Policies Which Provide for an Adjustable Maximum Rate of Interest on Policy Loans.
3208 - Antedating of Life Insurance Policies and Burial Agreements Prohibited.
3209 - Life Insurance, Annuities and Funding Agreements Disclosure Requirements.
3210 - Incontestability After Reinstatement.
3212 - Exemption of Proceeds and Avails of Certain Insurance and Annuity Contracts.
3214 - Interest Upon Proceeds of Life Insurance Policies and Annuity Contracts.
3215 - Disability Benefits in Connection With Life Insurance and Annuities.
3216 - Individual Accident and Health Insurance Policy Provisions.
3217-A - Disclosure of Information.
3217-C - Primary and Preventive Obstetric and Gynecologic Care.
3217-D - Grievance Procedure and Access to Specialty Care.
3217-E - Choice of Health Care Provider.
3217-F - Prohibition on Lifetime and Annual Limits.
3217-G - Maternal Depression Screenings.
3217-H - Telehealth Delivery of Services.
3217-I - Essential Health Benefits Package and Limit on Cost-Sharing.
3217-J - Utilization Review Determinations for Medically Fragile Children.
3218 - Medicare Supplemental Insurance Policies.
3220 - Group Life Insurance Policies; Standard Provisions.
3221 - Group or Blanket Accident and Health Insurance Policies; Standard Provisions.
3224 - Standard Claim Forms; Accident and Health Insurance.
3224-B - Rules Relating to the Processing of Health Claims and Overpayments to Physicians.
3224-C - Coordination of Benefits.
3224-D - Prescription Synchronization.
3225 - Eligibility for Health Insurance in Cases of Exposure to Des.
3226 - Reinsurance Contracts Excepted.
3227 - Interest Upon Surrenders, Policy Loans and Other Funds.
3228 - Individual Accident and Health Insurance Policies; Premium Refund at Death of Insured.
3229 - Minimum Benefit Standards for Certain Long Term Care Plans.
3231 - Rating of Individual and Small Group Health Insurance Policies; Approval of Superintendent.
3231*2 - Health Insurance Policies and Subscriber Contracts; Prohibited Claims.
3232 - Pre-Existing Condition Provisions in Health Policies.
3232-A - Certification of Creditable Coverage.
3233 - Stabilization of Health Insurance Markets and Premium Rates.
3234 - Pre-Existing Condition Provisions in Group and Blanket Disability Policies.
3234*2 - Limitations on Administrative Services and Stop-Loss Coverage.
3236 - Public Health Law Assessments.
3237 - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.
3238 - Pre-Authorization of Health Care Services.
3240*2 - Student Accident and Health Insurance.
3242 - Prescription Drug Coverage.
3245 - Liability to Providers in the Event of an Insolvency.